Healthcare Provider Details

I. General information

NPI: 1205327939
Provider Name (Legal Business Name): NEUROLOGY CENTER OF NORTH FLORIDA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2018
Last Update Date: 02/24/2021
Certification Date: 11/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4241 NW AMERICAN LN
LAKE CITY FL
32055-4881
US

IV. Provider business mailing address

4241 NW AMERICAN LN
LAKE CITY FL
32055-4881
US

V. Phone/Fax

Practice location:
  • Phone: 386-288-5311
  • Fax: 386-288-0058
Mailing address:
  • Phone: 386-288-5311
  • Fax: 386-288-0058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State

VIII. Authorized Official

Name: ERNESTO ALONSO
Title or Position: NEUROLOGIST
Credential: MD
Phone: 305-343-6831